In the fall of 2010, Madison Center's finances crumbled faster than anyone expected, calling on Oaklawn to take over thousands of outpatient cases.
Memorial Hospital took the inpatient care in 2011.
"We didn't have a five-year plan to get into the mental health field," Connie McCahill said of those initial days as the new Memorial Epworth Center grew to 88 beds.
Both McCahill, who's director of Memorial Epworth, and Oaklawn CEO Laurie Nafziger recall their passion to rejuvenate care that had gone limping after Madison Center's bondholders cut so much staff in the name of survival.
"For a while we all worked crazy hard," Nafziger said. "I got a certain amount of good will (from employees) -- that things had been so bad, this will be better."
As that chapter fades into history, the two mental health providers face burdens that they didn't create. State cuts, for example, make it hard for Memorial to find a permanent home for some patients. And at least one nonprofit agency has trouble absorbing the demand for care.
Will it float?
Oaklawn took the outpatient side of care and claimed the state designation as the community mental health center for St. Joseph County. Its operations suddenly mushroomed by 60 percent, moving beyond just Elkhart County and absorbing more than 200 staff from Madison Center.
Memorial Epworth took the inpatients -- that is, those who stay overnight.
It closed the old child and adolescent unit because it didn't meet Memorial's standards and then completely renovated and reopened it. Memorial Epworth also "significantly" improved care, McCahill said, by spending hundreds of thousands of dollars on training for its clinical staff.
Oaklawn and Memorial Epworth now share the campus that Madison Center used to occupy just east of the river near downtown South Bend.
Asked if Memorial Epworth is supporting itself financially, McCahill said, "Not yet."
"We're becoming more efficient," she added. "Our trend is going in the right direction. Memorial never intended this to be a huge cash cow. We got into it because there was a need for the community. My goal is that we will achieve a level where we can at least break even."
Could it even contribute to the bottom line?
"If we provide quality care," she said.
Madison Center was large and complex, and the public's memories of it run the gamut.
"People get a bad taste in their mouth, and it's hard to get rid of that," said Geoff Samora, a licensed clinical social worker with a private practice in South Bend. When he hears gripes about Madison Center, he often responds, "But they had some good people (staff)."
Seeking state beds